wisconsin department of health services january 2014 p-00522t healthiest wisconsin 2020 baseline and...
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Wisconsin Department of Health ServicesJanuary 2014 P-00522T
Healthiest Wisconsin 2020 Baseline and Health Disparities Report
Hispanics/Latinos
HISPANIC/LATINO POPULATION
Background• Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities
Report • Key points
Data• Demographic and socioeconomic data• Access to and use of health care services• Risk behaviors and health outcomes
References
Links to additional reports and resources
Contacts
Chapter Outline
Chapter outline
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HISPANIC/LATINO POPULATION
Report Overview
• This chapter is part of a larger report created by the Wisconsin Department of Health Services to track the progress on objectives of Healthiest Wisconsin 2020 (HW2020) and identify health disparities in the state. The full report is available at: http://www.dhs.wisconsin.gov/publications/P0/p00522.pdf
• The report is designed to address the Health Focus Areas in HW2020. Where direct measures exist, data are presented; where direct measures are not available, related information may be included.
• Information about populations experiencing health disparities is provided in the Health Focus Area chapters and is summarized in separate chapters devoted to specific populations.
• Technical notes are available at: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf
Report overview
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HISPANIC/LATINO POPULATION
Report Format
Full Report• Format: PDF • Intended use: reference document
Chapters• Format: Annotated PowerPoint slide set• Intended uses: presentations to
– Decision-makers– Service providers– Community leaders– The public
Sample annotated slide
Report overview
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HISPANIC/LATINO POPULATION
Report Outline
Executive Summary
Section 1: Introduction
Section 2: Demographic overview
Section 3: Health focus areas
Section 4: Infrastructure focus areas
Section 5: Data summaries by population
Section 6: Technical notes
Report overview
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HISPANIC/LATINO POPULATION
Report Outline: Detail
Section 3: Health focus areas
• Alcohol and other drug use• Chronic disease prevention and management• Communicable diseases• Environmental and occupational health• Healthy growth and development• Injury and violence• Mental health• Nutrition and healthy foods• Oral health• Physical activity• Reproductive and sexual health• Tobacco use and exposure
Section 4: Infrastructure focus areas• Access to health services
Report overview
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HISPANIC/LATINO POPULATION
Report Outline: Detail
Section 5: Data summaries by population
Racial/ethnic minority populationso American Indianso Asianso Blackso Hispanics
People of lower socioeconomic status People with disabilities Lesbian, gay, bisexual, and transgender populations Geography
Report overview
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HISPANIC/LATINO POPULATION
Data notes
• Please refer to the Technical Notes chapter for a more detailed description of limitations and methods: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf
• The 95% confidence intervals are denoted by error bars. Where
confidence intervals do not overlap, as shown in the example on
the right, differences are statistically significant. Larger confidence
intervals may indicate less reliable estimates that should be
interpreted with caution.
• Population estimates that are considered unreliable are excluded.
• Misclassification of racial/ethnic groups may affect the accuracy of rates.
• Unless otherwise indicated, the Hispanic population may include people of various races; Whites, Blacks, Asians, and American Indians are non-Hispanic.
Report overview
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HISPANIC/LATINO POPULATION
Factors that influence health
Social determinants
of health
Source: University of Wisconsin Population Health Institute. County Health Rankings 2013, http://www.countyhealthrankings.org/our-approach
Report overview
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HISPANIC/LATINO POPULATION
Historical trauma• Historical trauma is the cumulative exposure to traumatic events
that not only affect the individual exposed, but continue to affect subsequent generations.
• Descendants of those who experienced the traumatic stressor may still exhibit symptoms.
• Populations affected by historical trauma include American Indians, African Americans/Blacks, Hispanics/Latinos, Asians, immigrants and refugees, war veterans, and families experiencing intergenerational poverty.
• Current manifestations may include:• Mistrust of health care, legal, and educational systems; • Higher rates of risk behaviors such as alcohol and drug abuse,
suicide, homicide, and domestic violence; and • Higher rates of chronic diseases.
Report overview
Sources: SAMHSA, Fact Sheet: Historical Trauma http://gainscenter.samhsa.gov/cms-assets/documents/93078-842830.historical-trauma.pdf, Texas Department of Health Services, Trauma Informed Care Training, http://www.dfps.state.tx.us/Training/Trauma_Informed_Care/page35.asp
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HISPANIC/LATINO POPULATION
Key Points: Hispanic/Latino population
• Demographics: The Hispanic/Latino population in Wisconsin is younger than the general population, widely distributed geographically, and growing.
• Socioeconomic status: Hispanics in Wisconsin are more likely to live in poverty and less likely to have a college degree compared to non-Hispanic Whites.
• Access to health care: Hispanics have less access to health care compared to other racial/ethnic groups.
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Key points
HISPANIC/LATINO POPULATION
Key Points: Hispanic/Latino population
• Key health issues for Hispanic adults include: consequences of lack of exercise, obesity, high blood pressure, diabetes, unintended pregnancies, lack of emotional support, and (among Hispanic men) alcohol and tobacco use.
• Better data on Hispanics are needed due to small sample sizes, racial/ethnic misclassification, data access issues, and differences between foreign- and U.S. born- Hispanics.
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Key points
HISPANIC/LATINO POPULATION
Demographic and socioeconomic data
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HISPANIC/LATINO POPULATION
Demographic characteristics
Wisconsin’s Hispanic/Latino population is increasing in numbers, young, and diverse in terms of country of origin. Nearly one-third are foreign born.
• Wisconsin's Hispanic population, 2010: 336,056; 5.9% of state total
• Change in the Hispanic population, 2000 to 2010: 73% increase
• Median age, 2010: Hispanic, 23 years (Whites, 41.5 years)
The median age is the age at which half the population is older and half is younger.
• Percent of Hispanics who were foreign-born, 2010: 32% (Total population, 4%)
Sources: http://www.dhs.wisconsin.gov/health/MinorityHealth/Report.htm and U.S. Census Bureau.
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Demographic and socioeconomic data
HISPANIC/LATINO POPULATION
Socioeconomic data
Wisconsin’s Hispanic population has a higher poverty rate and less education compared to Whites.
• Median household income in Wisconsin, 2008-2010: Hispanics, $36,800 (Whites, $53,000)
• Poverty rate, 2010: Hispanics, 28% (Whites, 10%) The poverty rate is the percent living below the federal poverty level.
• Bachelor’s degree or more education (age 25 and older), 2007-2010: Hispanics, 11% (Whites, 27%)
• Married-couple households as a percent of family households, 2008-2010: Hispanics: 61% (other racial/ethnic groups range from Blacks, 33% to Whites, 82%)
Source: http://www.dhs.wisconsin.gov/health/MinorityHealth/Report.htm and U.S. Census Bureau, American Community Health Survey.
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Demographic and socioeconomic data
HISPANIC/LATINO POPULATION
Hispanic/Latino population by county, Wisconsin, 2010
Source: U.S. Census, 2010.
Demographic and socioeconomic data
Hispanic35 - 3,522
3,523 - 12,124
12,125 - 28,925
Hispanics as a percentof total population
0.6% - 2.3%
2.4% - 4.3%
4.4% - 7.6%
7.7% - 13.3%
126,039
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HISPANIC/LATINO POPULATION
Level of urbanization of Wisconsin residents, by race/ethnicity, 2007-2011
Source: American Community Survey, 2007-2011..
White Black American Indian Asian Hispanic0%
10%
20%
30%
40%
50%
60%
70%
80%
11% 67% 12% 24% 37%59% 28% 39% 66% 48%30% 4% 49% 10% 15%
Milwaukee CountySmaller metropolitan countiesNon-metropolitan counties
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Demographic and socioeconomic data
HISPANIC/LATINO POPULATION
Source: American Community Survey, 2010.
Country of origin of foreign-born Hispanic/Latino residents, Wisconsin, 2010
Mexico; 80%
South America; 9%
Central America; 7%
Carribean; 3% Other; 2%
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Demographic and socioeconomic data
HISPANIC/LATINO POPULATION
Access to and use of health care services
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HISPANIC/LATINO POPULATION
Lack of health insurance coverage and Medicaid enrollment among Wisconsin adults, by race/ethnicity, 2008-2011
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.
Access to health care
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No health insurance coverage, ages 18-64
Receive Medicaid or BadgerCare, all adults
0%
10%
20%
30%
40%
50%
60%
13% 12%19% 39%35% 21%19% 27%
WhiteBlackHispanicAmerican Indian
HISPANIC/LATINO POPULATION
Public health insurance coverage and inadequacy of health insurance among children ages 6-17, by race/ethnicity, Wisconsin, 2011-2012
Source: 2011-2012 National Survey of Children's Health. Note: Wisconsin estimates were only available for White, Black, and Hispanic children.
Public insurance Current insurance not adequate0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
27% 26%71% 26%51% 22%
WhiteBlackHispanic
Access to heath care
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HISPANIC/LATINO POPULATION
Age-adjusted rates of use of and barriers to health care among Wisconsin adults, by race/ethnicity, 2008-2011
Did not have a doctor's visit in past year
Do not have a personal doctor Unable to obtain medical care due to cost
0%
10%
20%
30%
40%
50%
60%
35% 16% 10%21% 16% 18%33% 20% 20%25% 17% 21%33% 16%
White Black
Hispanic Asian
American Indian
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.
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Access to health care
HISPANIC/LATINO POPULATION
Age-adjusted rates of tooth removal and dental visits in the past year among Wisconsin adults, by race/ethnicity, 2008-2011
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Tooth removal question asked in 2008, 2010, and 2011. Dentist visit question asked in 2008 and 2010.
Had at least 1 permanent tooth removed Did not visit dentist within past year0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
35% 27%60% 35%46% 44%40% 20%51% 44%
WhiteBlackHispanicAsianAmerican Indian
Oral Health
23
HISPANIC/LATINO POPULATION
Source: 2011-2012 National Survey of Children's Health.Note: Wisconsin estimates were only available for White, Black, and Hispanic children.
Lack of routine preventive medical and dental care among children, by race/ethnicity, Wisconsin, 2011-2012
Did not receive routine preventive medical and dental care during the past 12 months 0%
10%
20%
30%
40%
50%
60%
70%
30% 42% 41%
WhiteBlackHispanic
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Access to health care
HISPANIC/LATINO POPULATION
Risk factors among youth and adults
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HISPANIC/LATINO POPULATION
Age-adjusted indicators of poor health status among Wisconsin adults by race/ethnicity, 2008-2011
Physical health
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group. 26
Fair or poor health Physical health not good on at least one day during past month
Of those with at least one day of poor health, percent whose poor health limited usual activities on
at least one day during past month
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
12% 35% 67%31% 49% 68%23% 42% 75%17% 46% 64%32% 78%
WhiteBlackHispanicAsianAmerican Indian
HISPANIC/LATINO POPULATION
Age-adjusted rate of physical inactivity among Wisconsin adults, by race/ethnicity, 2008-2011
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.
Did not participate in any physical activity in past month, other than at job
-10%
0%
10%
20%
30%
40%
50%
60%
22% 37% 33% 28% 26%
WhiteBlackHispanicAsianAmerican Indian
Physical Activity
27
HISPANIC/LATINO POPULATION
Obesity among children (ages 2-4 years) enrolled in WIC, by race/ethnicity, Wisconsin, 2001 and 2010
White Black Hispanic Asian American Indian0%
5%
10%
15%
20%
25%
30%
35%
40%
10% 8% 16% 18% 18%12% 11% 18% 17% 27%
2001 2010
Source: Centers for Disease Control and Prevention (CDC) Pediatric Nutrition Surveillance Survey, 2010.Note: Based on >= 95th growth chart percentiles for Body Mass Index for age. WIC is the Supplemental Nutrition Program for Women, Infants, and Children.
Nutrition
28
HISPANIC/LATINO POPULATION
Age-adjusted rate of frequent mental distress among Wisconsin adults, by race/ethnicity, 2009-2011
Frequent mental distress 0%
5%
10%
15%
20%
25%
30%
35%
40%
9% 18% 18% 11%
WhiteBlackHispanicAmerican Indian
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Question asked in 2009-2011. Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.
Mental health
29
HISPANIC/LATINO POPULATION
Age-adjusted rate of insufficient sleep and rate of poor emotional support among Wisconsin adults, by race/ethnicity, 2008-2010
Mental health
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Questions were not asked in 2011. Rates of insufficient sleep are age-adjusted; rates of poor emotional support are not age-adjusted. Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.
Insufficient sleep Sometimes, rarely, or never receive emotional support0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
20% 16%23% 27%23% 28%18% 23%
White Black
Hispanic American Indian
30
HISPANIC/LATINO POPULATION
Age-adjusted rate of smoking among Wisconsin adults, by race/ethnicity, 2008-2011
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.
Tobacco use and exposure
Current smoker0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
20% 29% 27% 34%
White Black
Hispanic American Indian
31
HISPANIC/LATINO POPULATION
Unintended pregnancy as a percent of births, by race/ethnicity, Wisconsin, 2009-2011
Healthy growth and development
Source: Wisconsin Department of Health Services, Division of Public Health, PRAMS, 2009-2011. 32
Percent of births in which pregnancy was unintended0%
10%
20%
30%
40%
50%
60%
70%
32% 65% 43%
White Black
Hispanic
HISPANIC/LATINO POPULATION
Health Outcomes
33
HISPANIC/LATINO POPULATION
Age-adjusted rates of high cholesterol and high blood pressure among Wisconsin adults, by race/ethnicity, 2009 and 2011
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Questions only asked in 2009 and 2011.Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.
Ever been told you have high cholesterol Ever been diagnosed with high blood pressure0%
10%
20%
30%
40%
50%
60%
31% 25%40% 39%28% 35%23% 38%
White Black
Hispanic American Indian
Chronic diseases
34
HISPANIC/LATINO POPULATION
Age-adjusted rates of diabetes and prediabetes among Wisconsin adults, by race/ethnicity, 2008-2011
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Diabetes excludes women who were diagnosed during pregnancy, and does not differentiate between type 1 and type 2 diabetes. Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.
Ever been diagnosed with diabetes Ever been told you have prediabetes0%
5%
10%
15%
20%
25%
7% 6%17% 7%10% 8%16%
WhiteBlackHispanicAmerican Indian
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Chronic diseases
HISPANIC/LATINO POPULATION
Hospitalizations due to long-term complications from diabetes among Wisconsin adults, age-adjusted rate per 10,000, by race/ethnicity, 2010
Source: Wisconsin Inpatient Hospitalization Discharges, 2010.Note: Hospitalization rates considered unreliable are excluded.
0
5
10
15
20
25
30
5.6 2.026.3 7.414.9 17.1
White Black
Hispanic Other
Rat
e p
er
10
,00
0 p
op
ula
tio
n
36
Chronic diseases
HISPANIC/LATINO POPULATION
Incidence of end-stage renal disease incidence among Wisconsin adults, by race/ethnicity, age-adjusted rate per 100,000, 2009
Incidence of end-stage renal disease with diabetes as primary diagnosis0
10
20
30
40
50
60
8.7 45.1 44.3
WhiteBlackHispanic
Age-
adju
sted
rate
per
100
,000
pop
ulati
on
Source: United States Renal Data System (USRDS), Renal Data Extraction and Referencing (RenDER) System.Note: Incidence rates considered unreliable are excluded.
37
Chronic diseases
HISPANIC/LATINO POPULATION
Reported cases of HIV (ages 15-59) by race and ethnicity, rate per 100,000, Wisconsin, 2007-2011
Source: Wisconsin HIV Surveillance System.Note: Hispanic population may include individuals of various races.
Reproductive and sexual health
Male Female0
10
20
30
40
50
60
70
80
6169 2529 69 76
White Black
Hispanic Asian
American Indian
Ra
te p
er
10
0,0
00
po
pu
lati
on
38
HISPANIC/LATINO POPULATION
References
1. Overview of Race and Hispanic Origin: 2010, 2010. Census Briefs, March 2011. http://www.census.gov/prod/cen2010/briefs/c2010br-02.pdf
2. University of Wisconsin Population Health Institute. County Health Rankings, 2013. http://www.countyhealthrankings.org/our-approach
3. Center for Urban Population Health. Milwaukee Health Report, 2011. http://www.cuph.org/mhr/2011-milwaukee-health-report.pdf
4. LaVeist TA, Gaskin DA, Richard P (2009). The Economic Burden of Health Inequalities in the United States. Joint Center for Political and Economic Studies. http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf
5. Thomas JC, Sage M, Dillenberg J, Guillory VJ (2002). A Code of Ethics for Public Health. Am Journal of Public Health. 92(7):1057–1059. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447186/
6. Wisconsin Department of Health Services (DHS). Healthiest Wisconsin 2020. http://www.dhs.wisconsin.gov/publications/P0/P00187.pdf
7. Centers for Disease Control and Prevention (CDC). Health Care: See Why Being Insured Matters. http://www.cdc.gov/features/vitalsigns/HealthcareAccess/
8. Cheung PT, Wiler JL, Lowe RA, Ginde AA (2012). National Study of Barriers to Timely Primary Care and Emergency Department Utilization Among Medicaid Beneficiaries. Annals of Emergency Medicine. 60(1). http://www.annemergmed.com/webfiles/images/journals/ymem/FA-PTCheung.pdf
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References
HISPANIC/LATINO POPULATION
9. Kaiser Commission on Medicaid and the Uninsured. Next Steps in Covering Uninsured Children. Findings from the Kaiser Survey of Children’s Health Coverage. http://kaiserfamilyfoundation.files.wordpress.com/2013/01/7844.pdf
10. CDC. Regular Check-Ups Are Important. http://www.cdc.gov/family/checkup/
11. American Dental Association. American Dental Association Statement on Regular Dental Visits. http://www.ada.org/8700.aspx
12. CDC: Physical Activity. http://www.cdc.gov/physicalactivity/everyone/guidelines/index.html
13. CDC. Obesity Prevalence Among Low-Income, Preschool-Aged Children - United States, 1998-2008. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5828a1.htm
14. CDC. Self-Reported Frequent Mental Distress Among Adults --- United States, 1993—2001. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5341a1.htm
15. CDC. Insufficient sleep is a public health epidemic. http://www.cdc.gov/features/dssleep/
16. CDC. Health-related quality of life: Well-being concepts. http://www.cdc.gov/hrqol/wellbeing.htm#four
17. CDC. PNSS Health Indicators. http://www.cdc.gov/pednss/what_is/pnss_health_indicators.htm#Smoking/Drinking Indicators
40
References
HISPANIC/LATINO POPULATION
18. CDC. Unintended Pregnancy Prevention. http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/
19. CDC. Cholesterol. http://www.cdc.gov/cholesterol/20. CDC. High Blood Pressure Facts. http://www.cdc.gov/bloodpressure/facts.htm21. CDC. National diabetes fact sheet: National estimates and general information on
diabetes and prediabetes in the United States, 2011. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf
22. Agency for Healthcare Research and Quality. Diabetes mellitus: hospital admission rate for long-term complications. http://www.qualitymeasures.ahrq.gov/content.aspx?id=38559
23. National Institute of Diabetes and Digestive and Kidney Disease. National Diabetes Statistics, 2011. http://diabetes.niddk.nih.gov/dm/pubs/statistics/
24. Ward MM, et al. Access to care and the incidence of end-stage renal disease due to diabetes. http://care.diabetesjournals.org/content/32/6/1032.full.pdf+html
25. CDC. Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm
41
References
HISPANIC/LATINO POPULATION
Links to additional reports and resources
• Centers for Disease Control and Prevention, Minority Health, Hispanic or Latino Populations: http://www.cdc.gov/minorityhealth/populations/REMP/hispanic.html
• Centers for Disease Control and Prevention, Immigrant and Refugee Health: http://www.cdc.gov/immigrantrefugeehealth/
• U.S. Department of Health and Human Services, Office of Minority Health, Hispanics/Latinos: http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=33
• American Diabetes Association: Información en Español: http://www.diabetes.org/espanol/
• The National Women’s Health Information Center (en Español): http://es.bodylogicmd.com/enlaces/the-national-womens-health-information-center
• National Alliance for Hispanic Health: http://www.hispanichealth.org/• National Council of La Raza: http://www.nclr.org/
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Links
HISPANIC/LATINO POPULATION
Contacts
Evelyn Cruz, Minority Health OfficerWisconsin Division of Public Health, Office of Policy and Practice AlignmentE-mail: [email protected]
Karl Pearson, DemographerWisconsin Division of Public Health, Office of Health InformaticsE-mail: [email protected]
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Contacts